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So I somehow ended up with Verizon as a downstream technology partner for authentication services for eRX.

They rammed the ‘new toolkit’ down our throats 2 weeks ago. The ‘new toolkit’ authentication process changed a about 3 step process into a 7 step process. That included re-entering your userid and password on EVERY eRX transaction. Yes, you have to re-login on EVERY patient EVERY time to authenticate. In 30 years of IT I have never had to do that.

Small problem: if you are supervising mid-levels like NP’s you might be doing that hundreds of times a week. That means that Verizon at minimum added 3 hours of work to my work week. Did I mention that after logging into the EHR system, then entering every time eRX 3 factors of authentication after multiple displays to check and re-check what you are doing it totally superfluously asks to the effect of do you really want to do this? Seriously? Uh yeah right after approximately 7-9 checks and re-checks I still am really not sure what I am doing. That adds up to hundreds of times a week that I have to answer do I really want to do this. They also actually hide the medication list on the authentication step. The old toolkit did not.

So let me get this straight: it adds many more steps to the process, hides the information you are approving then asks superfluously if I am sure what I am doing? The old toolkit did not hide what you are doing. The new toolkit adds a lot of work and is possibly hazardous. Yes Verizon, possibly dangerous to my care of patients.

And I told them so. Two months before it was rammed down our throats I told them in no uncertain terms that this is a disaster. That it would cost me 3 hours of time a week and that it is a user interface catastrophe.

Verizon did it any way.

Question for Verizon:

Do you really want to do this?
Do you really want to do this?
Do you really want to do this?
Do you really want to do this?

Years ago I read the cannon of the classic medical book “House of God” by Samuel Shem which reads: “…the House of God was sad and sick and cynical…like all our doings in the House…” At first, before I had worked in an actual hospital I thought the book itself was sick and cynical. After working in an actual hospital I re-read the book. I then found it hilarious for its uncomfortable truths, and did not think it was sick or cynical enough. Therein likes the crux of the matter with regard to very expensive large hospital EHR’s.

I’ve wondered for years why large hospital EHR deployments are reported to cost north of 100 million dollars. I’ve asked the question what is that software made of, Unicorn dust? I’ve also heard reports that the EHR company in question fields ‘an army’ of workers for its go-live. I’ve wondered what justifies all this and what justifies the giant budgets. In working in and around hospitals for 20 years now I’ve come to some conclusions.

As the House of God points out, the human tendency towards dysfunction, sabotage, infighting and more is alive and well. It is often exhibited in raw relief in hospitals from the lowest employee to the highest management. My theory is that’s precisely why these systems cost so much and why you have to field, maintain, and deploy an army of go-live personnel to do it.

The army is there to absorb and contain the dysfunction and tendency towards sabotage at all levels that can occur with a technology deployment. Most people resist change but they are more likely to change when the EHR stranger from afar representative is standing in their midst to be therapist through the change. People are also much less likely to sabotage, poison others, and lapse back into dysfunction with the stranger from afar representative standing right there.

Thus the hundred million dollar price tag. It isn’t the price of the hardware or software. It is the price of the change, absorption and redirection of dysfunctional tendencies while preventing sabotage.<

Open and important questions: How do you know you are not replacing one dysfunction with another? Will the new dysfunction be revealed only with time? Possibly a long time like years to decades? Who is watching the watchers, training the trainers and on what basis? Are we creating hydraulic empires and oligarchies with these proprietary systems being put in place? How long before they become the problem and not the solution?

Author: Ignacio H. Valdes, MD, MS has been thinking about and implementing EHR’s since 1985. He is managing member of Astronaut, LLC http://astronautvista.com Electronic Health Record which offers a VA compatible VistA variant for the private sector.

Cancellation of medication orders already sent to the Pharmacy by eRX is only possible with less than 2% of pharmacies. The SCRIPT standard allows for change/cancel and you can possibly send it with the ordering software but less than 2% of pharmacies can receive the order. Therefore for most pharmacies it can only be done by laboriously calling the pharmacy, being put on hold, giving the information and waiting for them to do it. We tell the patient to not fill what was incorrect and let the order expire. It is not optimal.

Wow, Houston Texas looks like it will be a hotbed of Health IT activities end of September early October. Astronaut VistA training, AMIA CMIO, Open Source Health Conference and Texas Health IT Summit. In chronologic order:

This article is yet another example of pervasive proprietary EHR statistical bias.

The linked article excludes an enormous segment: Veterans Affairs VistA, its close cousin IHS RPMS and its increasing number of private sector deployments. There are approximately 1,000 VA outpatient clinics and many more Indian Health Service outpatient clinics as well as more and more private sector deployments. Not counting them or pretending that they don’t exist gives an inaccurate view.

A Veterans Affairs requested VistA Modernization Report is now available. The good news: it prominently features and recommends open source and discusses the prospect of VA VistA as a national standard. The bad news is that it appears to be progressive while actually being regressive from current and past VA experience and practice.

Ubuntu Netbook Remix (reviewed version 10.4) is Linux like you’ve never seen before. It has a smooth, attractive, interface that works very well with the netbook form factor. It is a clear winner, as good as if not better than operating systems from enormous corporations. There was a gotcha on my HP Mini installation in an otherwise great work.

The 8th National Medical Banking Institute is an exciting cross-industry educational forum for the banking and healthcare communities. At the Institute, we explore how banks are improving healthcare by reducing costs and increasing access and the quality of healthcare.

The International Journal of Medical Banking (http://www.mbproject.org/journal) is intended to educate commerce, government and academia about medical banking principles and technologies.

CONNECT is an open source software gateway that connects an organizations health IT systems into health information exchanges using Nationwide Health Information Network (NHIN) conventions, agreements and cores services to better serve patients throughtout the country. Built through collaboration of more than 20 federal agencies, the CONNECT gateway can help organizations reap the benefits of health information exchange with other healthcare institutions nationwide.